Perfusion-Uk最新文献

We report the case of a 72-year-old male patient who presented with a progressive aortic arch aneurysm. To reduce surgical trauma, we planned the procedure using an upper partial sternotomy with continuous cardiac perfusion and moderate hypothermia. Two vents were inserted to provide sufficient relief to the heart during perfusion. The heart was perfused continuously under flow and pressure control. To treat the aneurysm, a Vascutec™ Thoraflex Hybrid prosthesis was implanted. Despite the minimally invasive approach of partial sternotomy and beating heart combined with moderate hypothermia, the procedure was performed safely, quickly and without complications. The operation required precise pre-planning of the anatomy, outstanding surgical expertise and excellent interdisciplinary cooperation with the anaesthetist and clinical perfusionist.

Purpose: Research on the safety and efficacy of del Nido cardioplegia in adult patients with reduced left ventricular ejection fraction (LVEF) is limited. We evaluated the effect of del Nido cardioplegia on early outcomes of cardiac surgery in this cohort.

Methods: PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched through August 2024 to conduct a meta-analysis comparing del Nido to other cardioplegia in adult patients with reduced LVEF (≤50%). Primary endpoint was early mortality, and secondary endpoints included morbidities, aortic cross-clamp time and postoperative LVEF before discharge. A random-effect model was used to estimate the pooled effect size.

Results: Seven studies met our eligibility criteria, including three propensity score-matched studies with a total of 1160 patients. Conventional blood cardioplegia was used exclusively as a control solution in the included studies. The incidence of early mortality was similar between the del Nido and control groups, with a pooled odds ratio of 0.94 [95% confidence interval: 0.52; 1.71] (p = .822). Postoperative stroke (p = .680), renal failure (p = .832), atrial fibrillation (p = .412), and aortic cross-clamp time (p = .153) were also comparable between the two groups. Postoperative LVEF was significantly higher in the del Nido group compared to the control group, with a standardized mean difference of 0.52 [95% confidence interval: 0.07; 0.96] (p = .034).

Conclusions: In adult patients with reduced LVEF undergoing cardiac surgery, del Nido cardioplegia provides comparable mortality and morbidity rates compared to conventional blood cardioplegic solutions, with the potential to offer protective effects on myocardial function.

Objectives: Compare outcomes of Del Nido (DN) versus conventional blood cardioplegia (BC) in the surgical repair of Tetralogy of Fallot (ToF).

Methods: Medical databases were searched to identify relevant clinical trials. Meta-analysis was conducted for primary (cardiopulmonary bypass [CPB] and aortic cross-clamp [ACC] times, hospital and intensive care unit [ICU] length of stay [LOS], mechanical ventilation time) and secondary (adverse events, lactate levels, volume of additional cardioplegia) endpoints. Analysis was conducted for DN versus conventional blood cardioplegia, and we performed sensitivity analysis with leave one-out analysis for the primary outcome.

Results: 4 randomized controlled trials were included (n = 275). Mean differences (MD) with 95% confidence intervals (CI) were calculated with a random-effects model. Groups had similar CPB (MD -5.76 minutes; [-23.32 to 11.80]; p = 0.52) and ACC (MD 3.06 minutes; [-13.64 to 7.52]; p = 0.57) times, ICU (MD -6.42 hours; [-25.62 to 12.78]; p = 0.51) LOS and additional cardioplegia volume (MD -195.18 mL; [-434.19 to 43.82]; p = 0.11). The DN group had shorter hospital LOS (MD -0.81 days; [-1.25 to -0.36]; p = 0.0003) and time under mechanical ventilation (MD -4.57 hours; [-8.73 to -0.42]; p = 0.03). There was no difference in mortality.

Conclusions: DN cardioplegia has similar clinical outcomes and operative times compared to conventional blood cardioplegia in ToF surgery.

Introduction: The recently recommended activated clotting time (ACT) to be maintained at the initiation of and during cardiopulmonary bypass (CPB) is ≥480 s. However, the post-unfractionated heparin (UFH) administration ACT occasionally does not exceed 480 s. Therefore, in this study, we retrospectively evaluated the factors influencing post-heparin administration ACT before initiating CPB.

Methods: In this retrospective study, patients aged <7 years who had undergone open-heart surgery with CPB between August 2021 and June 2023 were investigated. Those who lacked preoperative data or received antithrombin or fresh frozen plasma preparations prior to undergoing CPB were excluded. Multiple regression analysis was performed using the initial ACT as the dependent variable and preoperative covariates as independent variables.

Results: This retrospective study included 91 patients. The median age of the patients was 265 (interquartile range [IQR]: 127-750) days. The median initial ACT was 589 (IQR: 506-713) s. In 17 (19%) patients, the initial ACT was <480 s. Multiple regression analysis revealed a statistically significant association between the platelet count and initial ACT, with a regression coefficient of -5.26 (95% confidence interval [-8.56 to -1.95]) and standard regression coefficient of -0.39 (p = .002).

Conclusion: A high preoperative platelet count was associated with a reduced heparin response. Nevertheless, the platelet count cannot solely elucidate the heparin response, and further investigations are required to determine the predictive factors affecting this response.

Objective: Elderly patients are less likely to undergo surgery for an acute type A aortic dissection (ATAAD). This study aims to understand the risks of surgical treatment in patients 75 and older.

Methods: This was a retrospective study using an institutional database of patients who underwent ATAAD repair from 2007 to 2021. Outcomes were compared between patients <75 and patients $\ge$ 75. Logistic regression was performed for operative mortality, and Cox regression was performed for long-term mortality.

Results: A total of 601 patients underwent surgery for ATAAD, 112 (18.6%) of whom were ≥75. Patients ≥75 were significantly more likely to undergo hemiarch replacement (vs total arch replacement) and concomitant CABG. Operative mortality was 16.1% in patients ≥75 versus 10.2% in those <75 (p = 0.078). On multivariable logistic regression, age ≥75 was not significantly associated with operative mortality (p = 0.068). Effect of age on long-term mortality was time-dependent: on Cox regression, being 75 or older and within one-year post-discharge was significantly associated with an increased hazard of death (time-dependent HR 4.56; 95% CI, 2.31-9.06; p < 0.001), while age was not associated with an increased hazard of death after the first postoperative year (p = 0.779).

Conclusion: Despite reduced survival during the first postoperative year among patients 75 years and older, operative mortality and late survival were similar across each group. By implication, age alone should not be a deterrent to operative intervention in ATAAD patients, even though further investigation is needed to determine opportunities for improving survival during the first postoperative year after ATAAD repair.

Introduction: Isolated coronary ostial stenosis of both ostia is a rare, potentially life-threatening condition, occurring in 0.1%-0.2% of patients undergoing coronary angiography.

Case report: We present a case of a 69-year-old woman with a past medical history of breast cancer, who had been treated with radiotherapy, which most likely caused significant stenosis of both coronary ostia and likely accelerated aortic stenosis. Surgical angioplasty with autopericardium patch reconstruction of the left main coronary artery and right coronary arteries due to proximal stenotic disease was performed instead of venous or arterial bypasses with concomitant aortic valve replacement. The postoperative course was uneventful. There were no cardiovascular events 5 years after operation, and the patient remained free of any symptoms.

Conclusions: Surgical coronary angioplasty offers an alternative to conventional coronary artery bypass grafting in isolated coronary ostial lesions and is advantageous in restoring more physiological myocardial perfusion, especially in those cases when conduits are suspected to be fibrotic, scarred or stenosed after radiation therapy or if there is the need to preserve conduits for future myocardial revascularisation in young patients.

Background: Monitoring the anticoagulant effect of unfractionated heparin (UFH) in extracorporeal membrane oxygenation (ECMO) patients is complex but critically important to balance the risks of treatment related bleeding and circuit thrombosis. While guidelines recommend using more than one method to monitor UFH activity, the use of thromboelastometry (ROTEM) to monitor UFH in ECMO patients has not been investigated in detail.Methods: This is an observational, single-center retrospective study looking at adult ECMO patients on UFH that had ROTEM and thromboelastography (TEG) tests obtained concurrently. A total of 20 samples were obtained from nine patients during the study period, seven of which were on veno-arterial (VA) ECMO and two of which were on veno-venous (VV) ECMO.Results: Under institutional standard operating practice, when TEG and/or activated partial thromboplastin time (aPTT) were considered therapeutic, intrinsic thromboelastometry clotting time (INTEM CT) was only 1.2 times higher than the normal range. TEG based monitoring compared to aPTT based monitoring tended to result in lower anti-Xa levels and less intensive anticoagulation. For the total cohort, bleeding events, driven by the need for blood transfusions, were more common compared to ischemic events (77% vs 11%; p = 0.02).Conclusion: INTEM CT tended to be less sensitive to lower doses of UFH with a value of 1.2 times higher than the normal range when aPTT and/or TEG were considered therapeutic. Due to the relative insensitivity of ROTEM, our institution decided to continue to use TEG instead of ROTEM. Larger, multicenter trials may be helpful to validate these findings.

Introduction: The prolonged use of extracorporeal membrane oxygenation (ECMO) support is associated with increased consumption of platelets and hemolysis. The prognostic impact of thrombocytopenia prior to and during ECMO support on patient's short-, mid- and long-term outcomes has been critically evaluated and discussed over the last years. However, only few data have been published on thrombocytopenia caused by mobile ECMO support. The aim of this study was to evaluate the impact of thrombocytopenia on short-term outcomes and predictors of in-hospital mortality in patients supported by mobile ECMO for transportation and subsequent weaning in a tertiary centre.

Methods: This retrospective single-centre study analyzed a total of 117 patients requiring mobile veno-arterial (va) ECMO support and subsequent transportation from referral hospitals to our department from January 2015 until December 2021. A total of 15 patients had to be excluded from the analysis for missing data regarding baseline platelet count. Patients were divided into two groups: thrombocytopenia group (<130 × 109/L, n = 44) and non-thrombocytopenia group (≥130 × 109/L, n = 58). The primary outcome was in-hospital mortality. Secondary outcomes were successful ECMO-weaning, and the incidence of associated complications (bleeding, acute hepatic failure, acute renal failure, dialysis, and septic shock).

Results: The dialysis rate before ECMO initiation was significantly higher (p = .041) in the thrombocytopenia group compared to the non-thrombocytopenia group. The rates of bleeding complications (p = .032) and limb ischemia (p = .003) were significantly higher in patients with low platelet count. Moreover, complication rates of acute hepatic failure (p < .001), acute renal failure (p < .001) and dialysis (p = .033) were significantly higher in the thrombocytopenia group. Also, in-hospital mortality was significantly higher (p = .002) in patients with low platelet count before initiation of ECMO support.

Conclusion: Based on the results of the present study, patients with thrombocytopenia prior to mobile vaECMO support may be at significantly higher risk for associated complications and short-term mortality.

Background: The decision regarding intraoperative transfusion has traditionally been based on hemodynamic instability and estimated blood loss. We performed a systematic review to determine the validity of the oximetry method compared to standard of care for hemoglobin measurement.

Methods: A systematic literature review was conducted, and several libraries were searched from inception to March 31,2023. The primary outcome was comparing the mean difference between laboratory-derived hemoglobin and non-invasive, point-of-care hemoglobin measurement. Subgroup analysis included comparing the mean difference in the pediatric population and among female patients.

Results: A total of 276 studies were identified, and 37 were included. We found that the pooled mean difference varied qualitatively between adult and pediatric population (p value for heterogeneity <0.001). In adult populations, lab hemoglobin measurements were on average slightly higher than non-invasive measurements (mean difference = 0.23; 95% CI -0.13, 0.59), though there was greater heterogeneity across studies (I2 = 97%, p value = <0.001). In the pediatric population, most studies showed lab hemoglobin to be slightly lower (mean difference = -0.42; 95% CI -0.87 to 0.03).

Conclusions: In general, there was no clinically significant difference in mean hemoglobin among adult and pediatric populations. The percentage of female participants had no effect on the mean difference in hemoglobin.